Visual function in multiple sclerosis

Ashworth, Bryan; Aspinall, Peter; Mitchell, John D.

doi:10.1007/bf00155090

Cited by 30 publications

(25 citation statements)

References 30 publications

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“…Although previous studies have shown subclinical involvement of the visual pathways in MS [1,3,15,16] they have not been longitudinal as in our study. However, the Optic Neuritis Treatment Trial drew attention to the long-term effect of the subclinical activity in a MS subgroup [34].…”

Section: Discussioncontrasting

confidence: 64%

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Asymptomatic visual loss in multiple sclerosis

Lycke

Tollesson

Frisén

2001

Journal of Neurology

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Visual disturbances are common in multiple sclerosis (MS) and often a result of acute demyelinating optic neuropathy. Careful examination of MS patients, who have never suffered optic neuritis, may also reveal asymptomatic visual loss. This type of silent disease activity was investigated by computerised resolution perimetry, which has the potential to reflect the percentage of functional retino-cortical neural channels. The time of onset and the evolution of asymptomatic visual loss was investigated. One approach was to retrospectively select patients who never had suffered acute optic neuritis from a closely monitored MS population and re-examine them again. Sixteen patients were identified and vision was evaluated during a period of 5.5-9 years of follow-up and compared with that in 14 healthy controls. The mean channel percentage of the MS group was 89 +/- 19 % (SD) on entry into the study, compared with 110 +/- 15% (SD) of controls (p < 0.003). At termination of the study the mean percentage was essentially unchanged both in MS patients (87 +/- 21%, SD) and controls (110 +/- 19%, SD). The second approach was to test a group of 7 patients with MS or strongly suspected MS, with the same method, in close connection with their first clinical exacerbation. All cases lacked visual symptoms and none had previously had acute visual loss. Again, virtually all performed subnormally in the vision tests, and to the same degree as in the first group of patients. Results were compared with those obtained from 25 MS patients who had experienced one or more attacks of optic neuritis. Compared with controls the loss of functional retino-cortical neural channels was 20% in patients without a previous history of optic neuritis and 30 % in patients who previously had experienced optic neuritis. We conclude that asymptomatic visual loss seems to be a universal feature of MS and has a substantial impact on the visual pathways, that it is present already at the time of clinical onset of the disease, and that any progression thereafter is slow enough to elude detection during several years of follow-up.

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Section: Discussioncontrasting

confidence: 64%

“…This subclinical involvement has thereafter been found frequently in MS patients with VEP and psychophysical determinations of contrast sensitivity [1,3,15,16]. High-pass resolution perimetry was used in this study.…”

Section: Discussionmentioning

confidence: 98%

Asymptomatic visual loss in multiple sclerosis

Lycke

Tollesson

Frisén

2001

Journal of Neurology

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“…[3][4][5][6][7][8][9] Patients may remain impaired for edge detection (e.g., walking stairs), night vision, stereopsis, and motion detection. Further, when factors known to precipitate Uhthoff phenomena are present, VA can be compromised.…”

mentioning

confidence: 99%

Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy

Horton

Conger

et al. 2013

Neurology

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Objective: The objective of this randomized, double-blind, placebo-controlled, crossover study was to examine if patients with optic neuropathy would derive a therapeutic benefit from 4-aminopyridine (4-AP) treatment. Furthermore, the study was intended to determine if patients with certain P100 latencies or retinal nerve fiber layer (RNFL) measures would be more likely to respond to therapy.Methods: Patients were enrolled in a randomized, placebo-controlled, double-blind, crossover study of 10 weeks duration. Patients underwent visual evoked potentials (VEP), optical coherence tomography (OCT), and visual acuity before starting 5 weeks of either placebo or 4-AP. After 5 weeks, they completed a second evaluation (VEP, OCT, and visual acuity) and were crossed over between treatment arms. Five weeks later, they had their final evaluation. All investigators were blinded to treatment arm until after data analysis.Results: On average, patients had faster P100s on 4-AP when compared to placebo. A subset of patients had distinct responses to 4-AP as measured by improvements in visual acuity. Finally, eyes with an RNFL measure between 60 and 80 mm had the highest response rate.Conclusions: 4-Aminopyridine is useful for improving vision in patients with demyelinating optic neuropathy. Future clinical trials may be able to enrich a patient population for potential responders using OCT and VEP measures. Selecting patients for future trials should use RNFL measures as part of inclusion/exclusion criteria.

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“…One of the characteristic signs of multiple sclerosis (MS), both clinically and sub-clinically, is demyelinizating optic neuropathy [1,2,3,4,5]. The diagnosis of MS is evident in cases of acute retrobulbar optic neuritis (ON); however, ON might also occur silently at any time during the course of MS.…”

Section: Introductionmentioning

confidence: 99%

Nerve Fibre Layer Analysis with GDx with a Variable Corneal Compensator in Patients with Multiple Sclerosis

et al. 2007

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Purpose: To evaluate the ability of GDx with variable corneal compensator (VCC) compared to visual-evoked potentials (VEPs) and standard automated perimetry (SAP) in the detection of early optic nerve damage in patients with multiple sclerosis (MS). Methods: 46 eyes of 23 MS patients were included. Ten of them had a history of acute retrobulbar optic neuritis. A control group of 20 normal subjects was also included. All subjects underwent a complete ophthalmological examination and testing with SAP, GDx VCC and VEPs. Results: 19 eyes (41.3%) were abnormal with GDx VCC compared to 38 eyes (82.6%) with SAP and 31 (64.4%) with VEPs. In the optic neuritis group, 9 eyes (69.2%) had optic nerve pallor; SAP was abnormal in 8 of these eyes (61.5%) while VEPs and GDx VCC were abnormal in 6 eyes (46.1%). 2/20 eyes (10.0%) in the control group gave a false-positive abnormal result with SAP. GDx VCC and VEP were normal for all the eyes in the control group. Conclusions: GDx VCC is less able to detect early defects in MS patients compared to the currently used standard techniques of SAP and VEPs.

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Visual function in multiple sclerosis

Cited by 30 publications

References 30 publications

Asymptomatic visual loss in multiple sclerosis

Asymptomatic visual loss in multiple sclerosis

Effect of 4-aminopyridine on vision in multiple sclerosis patients with optic neuropathy

Nerve Fibre Layer Analysis with GDx with a Variable Corneal Compensator in Patients with Multiple Sclerosis

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